Monday, February 03, 2014

Book Review (#14 of 2014) How Medicaid Fails the Poor by Avik Roy

How Medicaid Fails the Poor is a "book" that is shorter than a Kindle Single, it's more like an essay or long-form article. I was disappointed in that, so as a result it only gets 2 stars. But I do recommend reading it, if you can find a free copy.

I have a few personal and professional connections to Medicaid, so I'm interested in it. Roy highlights several studies showing how Medicaid does not improve health outcomes significantly different than if the poor did not have health insurance. He promotes a few alternatives, and criticizes the Left for its intransigence.

Medicaid cost U.S. taxpayers $450 billion in 2013 and will cost another $7.4 trillion over the next 10 years. Roy says we could spend a fraction by adopting policies like Singapore and other countries have done, and achieve better outcomes.

The problem with Medicaid is that it pays doctors a fraction of what private insurance pays, so fewer and fewer doctors are willing to take Medicaid patients and may provide sub-standard care (people respond to incentives). This problem is worsened by the Affordable Care Act in that over 17 million people will enroll in Medicaid, widening the gap between those seeking care and those able to find it.

A Harvard-MIT study that has been in the news a lot recently has yet to show greatly improved outcomes, other than people feeling better mentally about having health care with Medicaid once they get it. Medicaid patients are still clogging the emergency rooms because they cannot find a doctor who will see them, driving up the cost for everyone.

I read a recent report on Kentucky's Medicaid system last week, a statewide survey found few complaints about access to medical care. I have not looked at how Kentucky's reimbursement rate compares to other states, but I do not doubt that the problem is worse elsewhere. 

Roy's preferred solution has been mentioned quite a bit over the years, namely mandated health savings plans (subsidized, perhaps) along with catastrophic insurance covered by the government.

"Singapore, which has a universal system of catastrophic coverage and health-savings accounts, spends one-seventh of what we spend on health care, with comparable results.

Another proposal are "concierge plans" where you pay a flat fee and a doctor has to see you as many times a month as you need. This is being implemented by some private practitioners and working well, according to Roy.

The book ends rather abruptly after introducing these concepts. As such, it's disappointing.





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